We carried out an announced comprehensive inspection at Howell Surgery on 6 November 2018 as part of our inspection programme. Our inspection team was led by a CQC inspector and included a GP specialist advisor.

At the last inspection in August 2015 we rated the practice as good overall.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information from the provider, patients, the public and other organisations.

The practice is rated as good overall.

This means that:

• People who used the service were protected from avoidable harm and abuse, and legal requirements were met.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• Patients’ needs were met by the way in which services were organised and delivered.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.

There were areas where the provider should make improvements are:

• Continue to monitor the newly implemented repeat prescription collection system, to ensure it is effective.
• Continue to monitor and ensure that equipment calibration and portable appliance testing is conducted on schedule.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Howell Surgery on 11 August 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• Dispensary staff undertook continuous professional development.

We saw an area of outstanding practice:

• The practice’s performance in monitoring and maintaining the health of patients with long-term conditions, many of whom were older patients, in line with current best practice guidelines was significantly better than that achieved nationally or locally.

However there were areas where the provider needs to make improvements namely:

• Review the process for identifying people who were carers so as to make the carers register a truer reflection of the practice situation.
• Review their guidance as to what might constitute a significant event and ensure staff were aware of it.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Howell surgery is a GP practice providing primary care services for around 4900 patients. There are three GPs who are in partnership. The main surgery is in the village of Brenchley, there is a branch surgery in the neighbouring village of Horsmonden. Howell surgery has its own medicine dispensary. Patients seen at the branch surgery may collect their medicines from Howell surgery following their consultation. During our inspection we visited Howell surgery only.

We only visited Howell Surgery in Brenchley for this inspection.

As part of the inspection we talked with the local Clinical Commissioning Group, the local Healthwatch, a member of the Patient Participation Group, patients who were at the Howell surgery on the day of the inspection, doctors and other clinical and non- clinical staff at the practice.

The patients we spoke with and those that left comment cards were very satisfied about the care and treatment they received. We did not receive any negative feedback with all patients saying they received very good or excellent care. Patients said that the appointment system worked very well and no one had any cause for complaint.

The practice provided caring, responsive, effective and well led services. Although the services provided by the practice were safe, we identified some concerns in relation to the storage of medicines.